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摘要: 目的 探讨含不规则抗体献血者血液洗涤方案和临床应用情况及献血者队伍屏蔽归队模式。方法 对RhD阴性确认、ABO正反定型不符、O细胞反应及医院反馈有不规则抗体的血液标本进行抗体筛查及抗体特异性鉴定，对检出抗体的献血者根据抗体类型及效价制定相应红细胞制品洗涤次数并发往临床，相应血浆制品均报废，同时建立不规则抗体阳性数据库并对检出抗体献血者根据效价和抗体类型建立屏蔽归队间隔期。结果 190 780例献血者中不规则抗体阳性者186例(0.097%)，非特异性抗体常规洗涤3次，特异性抗体且效价≤16洗涤3次，特异性抗体且效价>16洗涤4次，累计共制备186袋洗涤红细胞并再次检测符合要求发往临床，其总合格率为99.5%，效价≤16的合格率100.0%。对含不规则抗体献血者建立相应资料库，IgM型抗体显示适宜献全血并建议献血时再次进行抗体筛查；IgG型抗体暂缓12个月献血并建议献血时再次进行抗体筛查。结论 对不规则抗体阳性献血者建立屏蔽归队模式，对不规则抗体阳性血液根据抗体类型、效价建立制备洗涤方案，防止血液资源浪费并保留献血者人群。Abstract: Objective To investigate the blood washing scheme and clinical application of blood donors with irregular antibody and the shielding and returning model of blood donors.Methods Antibody screening and antibody specificity identification were carried out on blood samples with negative RhD confirmation, ABO positive and negative stereotyping, O-cell agglutination and hospital feedback with irregular antibodies, for blood donors with specific antibodies detected, the corresponding red blood cell products were washed according to the antibody type and potency and sent to the clinic, and the corresponding plasma products were scrapped, at the same time, a database of irregular antibody positivity was established, and a shielding interval was set for blood donors with antibodies detected according to titer and antibody type.Results Among the 190 780 blood donors, 186 cases(0.097%) were positive for irregular antibodies, washed 3 times routinely according to non-specific antibodies and specific antibody with a titer≤16, specific antibody with titer 16 was washed 4 times, a total of 186 bags of washed red blood cells were prepared and tested again to meet the requirements and sent to the clinic. The total qualified rate was 99.5%, and the qualified rate of titer≤16 was 100%. The corresponding database of blood donors with irregular antibody was established, IgM antibodies were shown to be suitable for whole blood donation and it was recommended that antibody screening be performed again when donating blood; Suspension of blood donation for IgG antibodies for 12 months and re-screening for antibodies at the time of donation were recommended.Conclusion Screening and returning mode should be established for irregular antibody positive blood donors, and washing scheme should be established according to antibody type titer to prevent waste of blood resources and retain blood donor population.
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Key words:
- antibody type /
- antibody specificity /
- antibody titer /
- blood application
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表 1 不规则抗体在性别、血型及献血次数中的分布结果比较
例 基本资料 不规则抗体检测结果 χ2 P 阳性 阴性 总例数 阳性率/% 性别 14.75 < 0.001 男 83 111 506 111 589 0.074 女 103 79 088 79 191 0.130 血型 18.60 < 0.001 A 47 59 595 59 642 0.079 B 77 53 391 53 468 0.144 O 41 58 154 58 195 0.070 AB 21 19 454 19 475 0.108 年龄/岁 9.66 0.046 18~25 37 44 258 44 295 0.084 25~35 84 66 244 66 328 0.127 35~45 42 48 861 48 903 0.086 45~55 22 28 373 28 395 0.077 55~60 1 2 858 2 859 0.035 献血次数/次 138.84 < 0.001 1 113 53 404 53 517 0.211 2 48 31 937 31 985 0.150 ≥3 25 105 253 105 278 0.024 
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表 2 2020—2022年不规则抗体类型及特异性分布情况
血型系统 例数 特异性 类型 例数 百分比/% Rh血型 45 抗-D IgM/IgG 10 5.38 抗-E IgG 21 11.29 抗-Ec IgG 7 3.76 抗-C IgG 3 1.60 抗-c IgG 1 0.54 抗-D+抗-C IgG 1 0.54 抗-D+抗-E IgG 1 0.54 抗-D+抗-G IgG 1 0.54 MNSs血型 61 抗-M IgM/IgG 55 29.57 抗-N IgM 4 2.15 抗-S IgM 2 1.08 P1Pk血型 7 抗-P1 IgM/IgG 7 3.76 Lewis血型 35 抗-Lea IgM/IgG 6 3.22 抗-Leb IgM 18 9.68 抗-Lea+抗-Leb IgM/IgG 11 5.91 ABO血型 7 抗-A1 IgM 5 2.69 抗-B IgM 2 1.08 非特异性 31 冷抗体、蛋白凝集等 IgM 31 16.67 合计 186 100.00
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表 3 186袋血液含不规则抗体效价与洗涤次数合格率结果
% 效价 一洗合格率 二洗合格率 三洗合格率 四洗合格率 ≤1 100.0(34/34) 100.0(34/34) 100.0(34/34) - 2 97.1(67/69) 100.0(69/69) 100.0(69/69) - 4 80.4(37/46) 93.5(43/46) 100.0(46/46) - 8 44.0(11/25) 76.0(19/25) 100.0(25/25) - 16 22.2(2/9) 55.5(5/9) 100.0(9/9) - >16 0(0/3) 0(0/3) 33.3(1/3) 66.7(2/3) 合计 81.2(151/186) 91.4(170/186) 98.9(184/186) 99.9(185/186)
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| 引用本文: |
杨红梅, 邹昕, 马思飞, 等. 抗体类型与效价在血液应用及献血者队伍保留中的应用探索[J]. 临床血液学杂志, 2024, 37(8): 590-593. doi: 10.13201/j.issn.1004-2806.2024.08.014
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| Citation: |
YANG Hongmei, ZOU Xin, MA Sifei, et al. Application of antibody type and titer in blood products and donor retention[J]. J Clin Hematol, 2024, 37(8): 590-593. doi: 10.13201/j.issn.1004-2806.2024.08.014
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